Patient Forms

Expert Orthodontic Care in North Potomac & Gaithersburg/Kentlands

At the office of Dr. Charles C. Harrington, we are proud to provide high-quality orthodontic care to patients throughout the North Potomac and Gaithersburg communities while maintaining a fun, friendly, and welcoming office environment. For your convenience, our new patient forms are available online. Completing these forms ahead of time will save you time at your first visit with us. 

Forms for New Orthodontic Patients

Online Forms

We strive to make orthodontic treatment a convenient process, and we're excited to now let our patients complete and submit their intake forms on our website. To submit online, simply fill out the forms below and click the "Submit" button at the bottom of each form. Doing so will complete the paperwork necessary to get you into our system, which will help save time during your first appointment with us. To help you fill out the form, you may want to have your medical insurance card and information with you to refer to. 

Printable Forms

For your convenience, we also offer forms that you can print and fill out at home then bring into our office for your first appointment. 

You'll need a PDF Reader to open these forms, so if you don't have one currently, we recommend downloading Adobe Reader.

Contact Your North Potomac & Gaithersburg/Kentlands Orthodontist

We hope these forms make the early stages of your treatment a little bit more convenient, and they're just one of the ways in which we try to make orthodontic treatment an easy process. As an orthodontic practice serving the North Potomac area, we're proud to offer a wide variety of treatment methods to our patients, and we strive to customize care to fit each patient's unique needs and lifestyle. If you have any questions about the treatments we offer, your orthodontic health in general, or you'd like to schedule an appointment with us, we're always happy to hear from you. Feel free to give us a call at 301-977-1441 or reach out to us at our contact page – or, if you'd like to go ahead and schedule a consultation at our North Potomac office, you can do so using our easy online form. We can't wait to hear from you, and we're excited to help you achieve the smile of your dreams!
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get_adobe_reader.gif *These forms require a PDF Reader in order to open.  If you do not have one installed, click on the link to the left to download Adobe Reader.

**We are committed to keeping your personal information secure. All of our online forms are submitted via a secure connection and are HIPPA compliant.